tbuckley/cabot-search huggingface dataset:
POS0532 GLOBAL ULTRASOUND SYNOVITIS SCORE MAY REFLECT DEVELOPMENT OF CHRONIC POST-CHIKUNGUNYA RHEUMATISM
Authors: H. Watson, J. Del Valle Mendoza, W. Silva Caso, M. Aguilar Luis, A. Nizzardo, G. Calusi, M. Mandron, M. A. D’agostino
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Chronic musculoskeletal (MSK) symptoms such as arthralgia and arthritis develop in up to half of patients after acute chikungunya virus (CHIKV) infection. While MSK complaints are common during the acute infection, chronic post-CHIKV rheumatism represents a more severe outcome and is usually assessed by joint counts, laboratory markers and patient-reported outcomes (PROs). Ultrasound (US) may be a practical tool for predicting and confirming the development of chronic CHIKV. <h3>Objectives</h3> To evaluate the clinical relevance of MSKUS findings in post-chikungunya rheumatism. <h3>Methods</h3> 80 patients with acute CHIKV infection were enrolled in a prospective cohort study in Jaén, Peru. Clinical exam, US scans using grey-scale and power Doppler (PDUS), and serum inflammatory markers were performed at inclusion and at 3-month follow-up. Patients completed the RAPID3 outcome assessment and a MSK stiffness questionnaire. Joint counts and PDUS scans included 20 pairs of joints. Global synovitis and tenosynovitis scores were calculated following the EULAR-OMERACT recommendations for rheumatoid arthritis (GLOESS). <h3>Results</h3> 59 patients (mean age 35 years, 68% female) were assessed both in the acute infection stage and at 3-month follow-up. 21 patients (35%) met strict criteria for defining chronic CHIKV rheumatism with a mean 4.4 (±2.2) tender joints and RAPID3 scores &gt;6. In the acute infection phase, global PDUS synovitis and tenosynovitis scores correlated moderately with tender joint count and with pain severity, joint stiffness and RAPID3 scores, but were not strongly predictive of patients who went on to develop chronic arthralgia. After 3 months, global PDUS synovitis scores correlated more strongly with tender joint count (r=0.53, p&lt;0.0001), pain severity (r=0.60, p&lt;0.0001), joint stiffness (r=0.53, p&lt;0.0001) and RAPID3 scores (r=0.60, p&lt;0.0001) (Table 1). <h3>Conclusion</h3> Global PDUS synovitis and tenosynovitis scores may be an objective measure of disease severity in patients developing chronic CHIKV rheumatism. Further validation with longer-term follow-up is needed. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Hugh Watson Shareholder of: Sanofi, Employee of: Sanofi, Evotec, Juana del Valle Mendoza Grant/research support from: Sanofi, Evotec, Wilmer Silva Caso Grant/research support from: Sanofi, Evotec, Miguel Aguilar Luis Grant/research support from: Sanofi, Evotec, Andrea NIzzardo Employee of: Evotec, Giulia Calusi Employee of: Evotec, Marie Mandron Employee of: Sanofi, Evotec, Maria-Antonietta D'Agostino Consultant of: Evotec.
POS0585-HPR EFFECTIVENESS OF INSPIRATORY MUSCLE TRAINING ON AEROBIC CAPACITY, RESPIRATORY FUNCTIONS AND RESPIRATORY MUSCLE STRENGTH IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS: A SINGLE-BLINDED RANDOMISED CONTROLLED TRIAL
Authors: D. C. Saraç, D. Bayraktar, D. Ozer Kaya, O. Altug-Gucenmez, D. Oskay
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Children with juvenile idiopathic arthritis (JIA) may present lower aerobic capacity, lung volumes, and respiratory muscle strength compared to their healthy peers [1]. <h3>Objectives</h3> This study aimed to investigate the effectiveness of inspiratory muscle training (IMT) on aerobic capacity, lung volumes, respiratory muscle strength, functional capacity, and quality of life in children with JIA. <h3>Methods</h3> Thirty-three children with JIA who were on the same biologic disease modifying anti-rheumatic drugs for at least three months were included and divided into two groups as exercise group (n=17, mean age: 15.1±2.2 years, 12 male) and control group (n=16, mean age: 15.7±1.6 years, 11 male). Exercise group performed IMT daily for eight weeks. Initial IMT load was set as the 60% of maximal inspiratory pressure (PI<sub>max</sub>) and was increased by %10 every two weeks. Control group received no additional intervention. Forced vital capacity (FVC), forced expiratory volume in one second (FEV<sub>1</sub>), FVC/FEV<sub>1</sub> ratio, PI<sub>max</sub>, and maximal expiratory pressure (PE<sub>max</sub>) were evaluated using a portable pulmonary function test device (Cosmed Pony FX, Rome, Italy). Participants performed a maximal Cardiopulmonary Exercise Test to measure maximal oxygen consumption (VO<sub>2peak</sub>), metabolic equivalent (MET) and maximal heart rate. Six-minute walking distance (6MWD) was used to evaluate lower-extremity related functional capacity. The Pediatric Quality of Life Inventory (PedsQL) 3.0 Arthritis Module was used to evaluate the quality of life. Participants were evaluated at baseline and at the end of eight weeks. <h3>Results</h3> The groups were similar at baseline. FVC, FEV<sub>1</sub>, PI<sub>max</sub>, PE<sub>max</sub>, VO<sub>2peak</sub>, and MET significantly improved at the end of eight weeks in the exercise group (p&lt;0.05), while no significant differences were observed in the control group (p&gt;0.05). The difference over time in FVC, FEV<sub>1</sub>, PI<sub>max</sub>, VO<sub>2peak</sub>, and MET were significantly higher in the exercise group compared to control group (p&lt;0.05, Table 1). No other between group differences were detected (p&gt;0.05). <h3>Conclusion</h3> IMT seems beneficial for improving respiratory functions in children with JIA. <h3>References</h3> [1]Alkady EA, Helmy HA, Mohamed-Hussein AA. Assessment of cardiac and pulmonary function in children with juvenile idiopathic arthritis. Rheumatol Int 2012;32(1):39-46. doi: 10.1007/s00296-010-1548-5. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0935 THE COURSE OF CYTOKINE AND CHEMOKINE GENE EXPRESSION IN CLINICALLY SUSPECT ARTHRALGIA PATIENTS DURING PROGRESSION TO INFLAMMATORY ARTHRITIS
Authors: J. Heutz, C. Rogier, E. Niemantsverdriet, S. Van den Eeden, P. De Jong, E. Lubberts, A. Geluk, A. Van der Helm – van Mil
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Autoantibody-responses rise years before onset of inflammatory arthritis (IA) and are stable during transitioning from clinically suspect arthralgia (CSA) to IA. Cytokine and chemokine levels also rise years before IA-onset. However, the course in the at-risk stage of CSA during progression to disease or non-progression is unknown. <h3>Objectives</h3> To increase the understanding of processes mediating disease development, we studied the course of cytokine, chemokine and related receptors gene expression in CSA-patients during progression to IA, and in CSA-patients who ultimately did not develop IA. <h3>Methods</h3> Whole-blood RNA-expression of 37 inflammatory cytokines/chemokines/related receptors was determined by dual-colour reverse-transcription multiplex ligation-dependent probe amplification, in paired samples of CSA-patients at CSA-onset and either at IA-development or after 24-months without IA-development. ACPA-positive and ACPA-negative CSA-patients developing IA were compared at CSA-onset and during progression to IA. GEE-models tested changes over time. A false discovery rate approach was applied. <h3>Results</h3> None of the cytokines/chemokine genes significantly changed in expression between CSA-onset and IA-development (Figure 1A). In CSA-patients without IA-development, G-CSF expression decreased (p=0.001), whereas CCR6 and TNIP expression increased (p&lt;0.001 and p=0.002, respectively) over a 2-year period (Figure 1B). Expression levels in ACPA-positive and ACPA-negative CSA-patients who developed IA were similar. <h3>Conclusion</h3> Whole-blood gene expression of assessed cytokines/chemokines/related receptors did not change significantly from CSA to IA-development. This suggests that changes in expression of these molecules may not be related to the final process of developing chronicity and may have occurred preceding CSA-onset. Changes in gene expression in CSA-patients without IA-development may provide clues for processes related to resolution. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
OP0091-HPR VISCERAL ADIPOSE TISSUE IS ASSOCIATED WITH CARDIORESPIRATORY FITNESS, BUT NOT WITH PHYSICAL ACTIVITY AND DISEASE VARIABLES IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS
Authors: K. Risum, K. Godang, N. Olarescu, H. Marstein, J. Bollerslev, H. Sanner
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Increased body fat is reported in juvenile idiopathic arthritis (JIA) and may, together with disease activity, represent risk factors for the development of cardiovascular disease (CVD). Visceral adipose tissue (VAT) is particularly associated with risk of CVD, but VAT has been scarcely examined in JIA. Physical activity (PA) and cardiorespiratory fitness (CRF) may counteract unfavorable body composition. <h3>Objectives</h3> To examine associations between VAT and PA, CRF and disease variables in patients with JIA diagnosed in the era of biologics. <h3>Methods</h3> 60 patients, aged between 10-16 years, with persistent oligo- or poly-articular disease (extended oligoarthritis and polyarticular RF +/-), were recruited consecutively at Oslo University Hospital in 2015. VAT (g) was estimated by dual-energy X-ray absorptiometry (DXA). PA was measured with accelerometers during seven consecutive days. CRF was directly measured as peak oxygen uptake (VO<sub>2peak</sub>) during a continuous graded exercise test on a treadmill until exhaustion. We assessed disease activity with the Juvenile Arthritis Disease Activity Scale 71 (JADAS 71) and functional disability with the Childhood Health Assessment Questionnaire (CHAQ). Cross-sectional associations were analyzed with univariate and multiple linear regression analyses. <h3>Results</h3> Complete data was available in 55 (47 girls) patients. Mean (SD) age was 13.4 (2.2) years. Median (25<sup>th</sup>-75<sup>th</sup> percentile) VAT (g), JADAS 71 and CHAQ were 61 (21-131), 3.2 (1.1-4.8) and 0.0 (0.0-0.3), respectively. Biologics was used as treatment by 23 (42 %) of patients. There was a significant inverse association between CRF and VAT (p=0.002) using univariate linear regression analysis (Table 1). Measures of PA and disease variables (JADAS 71 and CHAQ) were not statistically significantly associated with VAT. CRF was the only identified correlate for VAT in the best model fit, also after adjustments for age and sex. <h3>Conclusion</h3> In this well-treated patient cohort, CRF was inversely associated with VAT. Measures of PA and traditional disease variables were not associated with VAT. Our study supports that higher CRF is important for a healthy body composition, including VAT in patients with JIA. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
OP0118 INTEGRATED ANALYSIS OF SINGLE-CELL AND BULK RNA SEQUENCING DATA REVEALS CELLULAR HETEROGENEITY IN THE SKELETAL MUSCLE OF IDIOPATHIC INFLAMMATORY MYOPATHY
Authors: Z. Honglin, L. Hui, X. Yizhi, S. Xie, T. Ding, T. Huang, S. Liu, D. Liu, H. Zhang
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> IIMs-affected muscles showed diverse cellular microenvironments, and specific immune activation is involved in the different types of IIMs. Skeletal muscle cells exhibit immunobiological properties and act as nonprofessional antigen-presenting cells in IIMs. <h3>Objectives</h3> We sought to identify the skeletal muscle cells (SMCs) and immune cell populations in IIMs muscles and understand how alterations in these cell subpopulations lead to muscle damage. <h3>Methods</h3> We performed single-cell RNA-sequencing (scRNA-seq) on muscle tissues from 6 IIMs and 3 normal control (NC), and spatial transcriptomics from 2 IIMs and 1 NC. 76 IIMs and 10 NC were analysed by bulk RNA sequencing. <h3>Results</h3> From the scRNA-seq analysis, remarkable heterogeneity of SMCs and immune cells phenotypes were found and spatially organized in IIMs subgroups. They displayed diverse functions and cell-surface proteins. From the bulk RNA-seq deconvolution analysis, cell clusters with high expression of type 1 interferon-related genes, such as ISG15+ SMCs, CD4+ISG15+ T cells, FCN1+ISG15+ macrophages and KLRC1+XCL1+ NK cells, were specifically cloned in DM; Cell subpopulations involved in mitochondrial changes, such as Mito_high_CD8+ TEFFs, were expanded in anti-Jo1 ASS group, TPM1+ SMCs and Mito_high_NKs has the highest proportion in anti-SRP IMNM. Mito_high_NKs were positively correlated with serum creatine kinase (CK) in IIM patients. scRNA-seq and spatial transcriptomics combined analysis indicated ligand-receptor pairs MIF→(CD74+CD44)/(CD74+CXCR4) play key roles in the interactions of ANKRD2+ SMCs and inflammatory cells. The levels of CD44 and CXCR4 in muscle tissues were positively correlation with CK, lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase. <h3>Conclusion</h3> Our results demonstrate previously unrecognized SMCs and immune cells phenotypes in IIMs subgroups, and indicate the interactions of SMCs and immune cells are key pathological mechanisms driving muscle damage. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
OP0167 EULAR POINTS TO CONSIDER FOR PATIENT EDUCATION, PAIN MANAGEMENT AND PHYSICAL ACTIVITY ADAPTED TO THE SELF-MANAGEMENT OF JUVENILE-ONSET RHEUMATIC AND MUSCULOSKELETAL DISEASES DURING TRANSITIONAL CARE. THE EULAR MOVE-UP PROJECT
Authors: R. Prieto-Moreno, J. Courel-Ibañez, E. Briones-Vozmediano, S. Angevare, J. Anton, P. Ariza-Vega, I. Bini, D. Clemente, M. Correia, W. Costello, D. C. Diederik, A. Domjan, L. Leon Mateos, A. Marques, K. Minden, A. F. Mourão, A. Najm, S. Özen, G. Pimentel, Z. Saleem, T. Vetrovsky, N. Wulffraat, A. Zacarias, Y. Prior, L. Carmona, F. Estevez-Lopez
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The EULAR task force "Implementation of a mobile health app for the self-management of juvenile-onset rheumatic and musculoskeletal diseases (jRMDs) during transitional care" aims at designing, developing and implementing a self-management program through a smartphone app (i.e., the EULAR Move-Up app). The first step of this task force was to adapt the current EULAR recommendations/points originally developed for adults, to young people (YP) with jRMDs. <h3>Objectives</h3> Adapting EULAR recommendations/points for patient education, pain management and physical activity for self-management of jRMDs during transitional care. <h3>Methods</h3> A multidisciplinary taskforce of 25 members from 11 European countries was convened. Using a Delphi technique, the level of agreement was established by anonymous online voting in three rounds. <h3>Results</h3> Four overarching principles and 8 points to consider were formulated (Table 1). The agreement was high, ranging from 8.7 to 9.9. <h3>Conclusion</h3> This work will feed into an evidence-based framework to inform the development of the EULAR Move-Up app aiming at improving the quality of transitional care of jRMDs. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Rafael Prieto-Moreno: None declared, Javier Courel-Ibañez: None declared, Erica Briones-Vozmediano: None declared, Saskya Angevare: None declared, Jordi Anton: None declared, Patrocinio Ariza-Vega: None declared, Ilaria Bini: None declared, Daniel Clemente: None declared, Matilde Correia: None declared, Wendy Costello: None declared, De Cock Diederik: None declared, Andrea Domjan: None declared, Leticia Leon Mateos: None declared, Andrea Marques: None declared, Kirsten Minden Grant/research support from: Honoraria from Pfizer, Novartis and Medac., Ana Filipa Mourão: None declared, Aurelie Najm: None declared, Seza Özen: None declared, Georgina Pimentel: None declared, Zainab Saleem: None declared, Tomas Vetrovsky: None declared, Nico Wulffraat: None declared, Andrea Zacarias: None declared, Yeliz Prior: None declared, Loreto Carmona: None declared, Fernando Estevez-Lopez: None declared.
OP0133 DO JAKIS WORK THE BEST AMONG THOSE RA PATIENTS WHERE THEIR SAFETY CONCERNS ARE THE HIGHEST?
Authors: H. Bower, T. Frisell, D. DI Giuseppe, B. Delcoigne, J. Askling
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Safety is a driving factor when selecting treatment, but the risks should be balanced against the treatment benefits, relative to alternative treatment options. In JAKis, recent evidence of increased safety risks in older patients with cardiovascular (CV) risk factors, have led to concerns. However, an increased risk among certain patients might still be offset by an increasing benefit in the same patient segment, and vice versa. A full understanding of the JAKi benefit-risk profile thus requires a better understanding of the relative (JAKi vs other treatments) benefits in those patients where their relative safety profile may be worse. <h3>Objectives</h3> To assess the observed and adjusted relative effectiveness (remission and response) of JAKis (and non-TNFi bDMARDs) when compared to TNFi, as used in clinical practice, and to assess whether the predicted effectiveness of either drug class is modified by age and the presence of CV risk factors. <h3>Methods</h3> RA patients initiating treatment with a JAKi, non-TNFi, or TNFi 2016-2021 were followed using the Swedish Rheumatology Quality Register. Good EULAR response and remission (CDAI&lt;=2.8) at 6 months were assessed at return visits (within 90 to 270 days after treatment initiation). Non-responder imputation was implemented where treatment ended prior to 210 days after initiation. Crude probabilities of outcomes were presented by age and having ≥1 CV risk factor (Y/N). Linear regression estimated the risk difference (versus TNFi) in age and CV risk groups, adjusted for sex, baseline DAS28 (response) and CDAI (remission), and line of therapy. Probability of outcome was predicted from logistic regression models, fitted to allow effect modification of treatment cohort by age and CV risk score (ERS-RA score), adjusted for sex, baseline DAS28 (response) and CDAI (remission), and line of therapy. <h3>Results</h3> 10,309 treatment episodes contributed data on response at 6 months, and 12,016 episodes with data on remission. Overall, 21% achieved good EULAR response and 11% reached CDAI remission (Table 1). Crude observed risks overall indicated superior response and remission with TNFi versus JAKi (Table 1). Adjusted risk differences suggested superior outcomes in JAKi versus TNFi, overall, and in those with no CV risk for CDAI remission. Patterns of predicted response and remission varied across age and CV ERS-RA score (Figure 1), with JAKis having superior effectiveness overall once adjusting for line of therapy. <h3>Conclusion</h3> Age and CV risk may modify the absolute and relative effectiveness of JAKis vs. TNFi. Further analyses are planned with the aim of presenting these results at EULAR. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
OP0240 A RANDOMIZED CONTROLLED TRIAL TO COMPARE THE EFFICACY OF TACROLIMUS WITH MYCOPHENOLATE MOFETIL IN PATIENTS WITH SYSTEMIC SCLEROSIS - INTERSTITIAL LUNG DISEASE (INSIST TRIAL)
Authors: J. Mathew, C. Kopp, S. K. Sharma, V. Dhir, S. Dhooria, A. Sinha, S. Jain
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Interstitial lung disease in systemic sclerosis(SSc-ILD) is heterogeneous with limited therapeutic options. Mycophenolate mofetil (MMF) is the most commonly used first line agent for SSc-ILD. Tacrolimus has shown promising efficacy in few small case series, and large cohorts of patients with non-SSC-ILD[1], but has never been evaluated in the setting of a clinical trial. <h3>Objectives</h3> To compare the safety and efficacy of Tacrolimus with MMF in patients with progressive SSc-ILD. <h3>Methods</h3> In this single center open labelled, prospective, two-arm parallel group, randomized controlled pilot study (INSIST) conducted between November 2021 to December 2022, patients with progressive ILD (FVC decline &gt;10%) due to SSc, aged between 18-65 years, disease duration &lt;10 years, without concomitant inflammatory myositis, with an FVC of 40-85%, and not having received active immunosuppression other than prednisolone &lt;10mg/day in the last 6 months were randomized to receive either MMF (target dose 2gm/day) or tacrolimus (Max dose-0.075 mg/kg/day; target trough levels- 4-10ng/ml) for 24 weeks. The primary endpoint was the difference in change in FVC% at 24 weeks; secondary outcomes included absolute change in FVC, skin scores, 6-minute walk distance, Mahler's transitional dyspnea index, ACR-CRISS and revised CRISS responses and adverse outcomes. (Trial Reg: CTRI/2021/11/037864) <h3>Results</h3> 25 out of 26 patients (13 in each group) completed 24 weeks follow up. Majority had Anti-Scl 70 positivity (73%) and limited skin disease. At 24 weeks, the mean change in FVC was 4.4% (10.6) and 6.92%(8.4) in the MMF and tacrolimus groups respectively (difference 2.52%, 95% CI (-10.3 to 5.18); p-0.500). All patients on tacrolimus and 85% of patients on MMF had stabilization (<b>Δ</b>FVC% -5% TO 5%) or improvement (<b>Δ</b>FVC%&gt;10%) in lung function. Secondary outcomes were similar between two groups. Subgroup analyses stratified by ILD type, skin involvement at baseline, and early vs late SSc yielded similar results. The mean tacrolimus levels were 4.9 ng/ml(1.47) and the median dose needed to achieve these levels was 4mg/d. No serious adverse events were noted in either group; use of tacrolimus did not result in renal dysfunction or renal crises. <h3>Conclusion</h3> Tacrolimus resulted in comparable improvement to MMF across primary and secondary outcome measures at 24 weeks with a favorable safety profile in patients with SSc ILD. Larger studies with longer follow up are needed to investigate the role of calcineurin inhibitors in SSc. <h3>Reference</h3> [1]Ge Y, Zhou H et al. The efficacy of tacrolimus in patients with refractory dermatomyositis/polymyositis: a systematic review. Clin Rheumatol. 2015 Dec 1;34(12):2097–103. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.